The viral myocarditis with cardiac аrrhythmia as complication of COVID-19 in the practice of family doctor of the tuberculosis dispensary

BACKGROUND: About 70% of TB dispensary patients have chronic somatic diseases which not only prevent effective treatment of TB but also take progressive course themselves. AIMS: To timely detect and treat acute and chronic somatic disease combined with TB. MATERIALS AND METHODS: since 2020 the algorithm of patient complex investigation by specialists of therapeutic profile was developed in the Tuberculosis Dispensary No. 5, among them the general practitioner was the coordinator of the patients medical route. This became especially relevant during the COVID-19 pandemic. RESULTS: In accordance with the developed algorithms of diagnostic search the patient was comprehensively examined. There were no signs of tuberculosis were in him, however the general practitioner involving to specialists team could diagnose signs of complex cardiac arrhythmia the probable cause which was a new coronavirus infection that he had had six weeks before. CONCLUSIONS: The organization of a new form of medical service for phthisiatric patients allowed general practitioner to reveal serious cardiac pathology directly at the TB dispensary, to refer the patient for consultation to the cardiologist-arrhythmologist, to follow the patient and perform recommended cardiologic treatment simultaneously with measures or medical supervision over persons contacting with tuberculosis.

Structure of somatic diseases among youth in the Republic of Tajikistan and their range by sex

Aim. To study the structure of the morbidity of young people with somatic diseases according to the data on admittance.Material and methods. The research materials are based on data from the Republican Center for Medical Statistics and Information of the Ministry of Health and Social Protection of the Republic of Tajikistan and reports of the youth medico-advisory departments of the Health Centers.Results and discussion. In total, 58103 people contacted YMAD in all regions of Tajikistan over two years (2018- 2019), including 18070 boys (31,1%) and 40033 girls (68,9%). Somatic diseases were revealed in 1030 cases among boys (55,1%) and in 840 cases - among girls (44,9%). Among the main somatic diseases among young people, the most common are diseases of the urinary tract (35,3%; endocrine diseases (24,1%); anemia (17,6%); helminthic invasions (14,4%); diseases of the gastrointestinal tract (10,2%). The combination of two or more of the listed diseases was observed in young men in 71,4% of cases, and in young women in 28,6 cases.Conclusions. Thus, the data shows a low level of the somatic health index of young people, which undoubtedly affects the quality of life and creates an unfavorable background for the realization of reproductive function in the future. Chronic somatic diseases contribute to the discussion of the quality of life of young people in the physical and emotional spheres.

PREGNANCY DURING A PANDEMIC: PERINATAL EFFECTS OF PROLONGED STRESS AND WAYS OF CORRECTION (LITERATURE REVIEW)

Relevance: The article presents current evidence on the perinatal effects of prolonged stress on pregnancy during the COVID-19 pandemic.The currently known features of the post-covidsyndrome in general and in the female population in particular are indicated. The purposewas to determine the perinatal effects of prolonged stress during a pandemic and ways to correct them. Materials and method sincludedan analysis of the scientific literature on the topic available in the public domain. Results: The article reviews the peculiarities of the course of pregnancy and perinatal outcomes after suffering a coronavirus infection, as well as the manifestations of post-covid syndrome in this cohort of women. An increase in the frequency of anxiety-depressive disorders in pregnant women and women in labor during a pandemic and their effect on the further mental state of the fetus and the development of its brain has been noted. The specific consequences of prolonged stress were determined.It became known that pregnant women during a pandemic are exposed to prolonged stress, which affects the course of their gestational period. One should note an increase in the frequency of the threat of termination of pregnancy, premature birth and delivery in 17-28% cases; exacerbation of chronic somatic diseases during pregnancy; an increase in BMI on the eve of pregnancy and a pathological increase in body weight during pregnancy. The article also discusses the timely detection and possible ways to correct these conditions despite a transition to remote monitoring of pregnant women in quarantine; offers organizational, treatment, and preventive measures with the use of preparations of micronized progesterone, magnesium citrate, folates (metafoline) and vitamin D, as well as psychoprophylaxis and psychotherapy methods. Particular attention is paid to the role of magnesium in pregnancy and its neuroprotective and metabolic effects, in particular when used in the form of citrate in a soluble form. The authors state the main directions of rehabilitation for pregnant women and women in labor after suffering COVID-19. Conclusion: So, our current knowledge about the course and consequences of COVID-19 in pregnant women and women in childbirth is not yet perfect and not final, but it allows determining the directions of scientific and practical research for the next period.

MENTAL AND COMORBID CHRONIC SOMATIC DISEASES IN CHILDREN AND ADOLESCENTS

The need to analyze the phenomenon of a combination of diseases of various nature is dictated by its high prevalence and insufficient knowledge; it is known, that their comorbidity aggravates the course of the underlying disease, worsening its prognosis. Information about comorbidity is insufficiently systematized, materials about particular combinations of certain mental disorders with somatic ones prevail, there is clearly not enough information about the coexistence of mental and somato-neurological pathology recorded in children and adolescents. Objective: to study the prevalence and nosological distribution of chronic somatic, neurological, infectious comorbid diseases detected in children and adolescents suffering from mental disorders; analyze the social adaptation of these patients. Material and methods. We examined 602 patients, 410 boys (68%) and 192 (32%) girls, who were observed on an outpatient basis in one of the neuropsychiatric dispensaries in Moscow. The study included only cases of a combination of mental and chronic somatic, neurological, infectious and other diseases. To rank patients according to the level of social functioning in adolescence, the «Map of registration of social skills and abilities of adolescents with chronic mental disorders» was used. Research methods: clinical-psychopathological, statistical. Results. The most common comorbid pathology was orthopedic diseases, in the second place was the pathology of vision, in the third place was endocrine pathology, the fourth place was taken by neurological diseases, the fifth place was the pathology of the ENT organs. In combinations of mental and comorbid disorders, pathogenetic variants were observed: 1. comorbid diseases accompanied mental disorder; 2.comorbid and mental disorders were pathogenetically associated with each other, or occurred as a result of a single primary disorder or disease; 3. somatic diseases were mental complications; 4. The occurrence of somatic diseases was explained by the side effects of psychotropic therapy. The severity of social inadequacy depended both on the severity of mental pathology and on the severity and number of somatic diseases. A comorbid disorder can cause more significant difficulties in certain areas of life than the underlying disease. Conclusion. Comorbidity is a multicomponent negative phenomenon. To reduce the incidence of comorbid pathology and achieve its maximum compensation, a multidisciplinary approach is required.

Depression in patients in a somatic hospital

The aim of this work was to assess the prevalence and risk factors for depression in patients in a somatic hospital in the city of Izhevsk. The study group (94 adult patients) was compiled by the method of continuous sampling. The Russian version of M. I. N. I. 5.0.0 interview, Depression Scale were used for the diagnosis of depression. The prevalence of current depressive disorders was 19,1 %. Depression was more often diagnosed in patients with chronic somatic diseases (47,0 %), women (45 %), widowed or divorced patients (63,6 %), patients with psychological problems in the family (100 %). In patients with acute somatic illness, the current depressive episode correlated with the influence of psychological factors. In 64,2 % of patients with chronic somatic diseases with an identified depressive episode at the time of examination depression had a previous history. None of the patients with identified depression sought medical help or received antidepressant therapy.

ABNORMAL UTERINE BLEEDING IN PUBERTAL GIRLS, MANAGEMENT TACTICS

Abnormal uterine bleeding (AMC) is one of the most common pathologies of the reproductive system in girls of the pubertal period, which is certainly a medical and social problem. The solution of this issue has been relevant for many years, the main area of which is the development of preventive, diagnostic and therapeutic measures. The aim of the study was to study the features of the clinical picture of pubertal AMC, assessing the effectiveness of therapy. The study involved 140 girls from the city of Togliatti aged 10 to 15 years, who underwent a full clinical examination, assessment of psychological status, excluded chronic somatic diseases and diseases associated with a violation of the hemostasis system, sexual development according to Tanner corresponded to age norms. Two groups were formed: the first 30 girls diagnosed with abnormal uterine bleeding, who were on inpatient treatment, 110 girls received outpatient therapy. It has been established that AMCs are recurrent, which certainly requires preventive measures. The method of hemostasis in AMC should be selected individually, depending on the severity of bleeding and the characteristics of the clinical course. Antianemic therapy is necessary for all patients with signs of ZHD depending on severity, choosing the routes of administration of the drug, the duration of therapy.

Integral assessment of the population risk of generalized periodontal disease

Introduction. The development and prevalence of generalized periodontitis is caused by a combination of many factors: climatic, geographical, gender, age, presence of somatic pathology, etc. Aim. This study analyzes the population determinants of the risk of generalized periodontitis. Material and methods. Epidemiological surveys of the population of the adult population of Uzbekistan aged 20 and more than 60 years were carried out. Using regression analysis, we determined the contribution of risk factors for the development of periodontal diseases to the presence/absence of disease in the population. Results. In terms of impact on the occurrence of periodontitis, the factors are as follows: on the 1st place is the non-compliance with hygiene of the oral cavity, the contribution factor is 0.301 units; on the 2d the presence of chronic somatic diseases, 0.252 units; on the 3rd the predominance of carbohydrates in the diet, 0.252 units; on the 4th low income increases the presence of periodontitis to 0,139 units; on the 5th social conditions, 0.139 units; on the 6th smoking, 0.106 unit; 7th low social status that increases the risk of periodontitis in the population by 0.0524 units of measurement and on the 8th male sex, leading to an increase in the prevalence of periodontitis in the periodontal diseases by 0.0185 units of measurement. Conclusion. The data obtained allow us to calculate the load by risk factors. At the same time, in age groups, compared with the General sample, it changes from negative values in age groups up to and including 45 years and to positive values in elder people. Similarly, the additional risk of periodontitis due to the load of risk factors changes in the population.

Personal determinants of emotional states of somatic patients

The article contains the results of a study of personality predictors of emotional states of persons with chronic somatic diseases. The aim of the study was to identify the personality determinants of the emotional states of the physically ill. The study involved persons who are on dispensary observation with a general practitioner with various chronic somatic diseases (N = 50 people). It is shown that personality traits, resilience, level of self-esteem, prevailing protective mechanisms and the temporal perspective of the personality can be considered as personal determinants of the emotional states of patients.

Relationship between job burnout and somatic diseases: a network analysis

Job burnout, characterized by feelings of exhaustion, cynicism and reduced personal efficacy, has been defined as a risk state for the development of diseases, but its association with somatic diseases is underexplored. Study participants were 5671 respondents (mean age 44.1 years, range 18–70; 38.6% men) to an online survey of job burnout, using a mobile health web application. Respondents provided data on sociodemographic characteristics, symptoms of burnout, measured with the Maslach Burnout Inventory-General Survey, depressive symptoms, measured with the Profile of Mood States, and 11 categories of somatic diseases. Adjusting for age, sex, educational level, depressive symptoms, and all disease categories included, network analysis showed a significant association of high exhaustion with “high blood pressure” and a category of “other chronic somatic diseases”. Low personal efficacy showed a significant association with “chronic lung diseases”. In network analysis, clinically relevant depressive symptoms were also significantly associated with “high blood pressure”, “other chronic somatic diseases” and “skin diseases”. Logistic regression analysis confirmed these associations. Burnout dimensions were significantly associated with an increased risk for somatic diseases, independently of sociodemographic factors and clinically relevant depressive symptoms. This relationship seems particularly evident for the exhaustion dimension of job burnout.